An appraisal of canine and human cases reveals an endemic status of dirofilariosis in parts of Serbia.

Dirofilaria immitis and D. repens are mosquito-borne nematodes that primarily infect canids, and can also cause mild to serious superficial or visceral infection in humans. In the present survey, peripheral blood from 150 asymptomatic dogs from Serbia were examined using the modified Knott's technique. Dirofilaria immitis, identified based on morphological and morphometric characteristics, was prevalent in dogs not receiving preventative treatment (in 44% and 60% of pound and pet dogs, respectively). These results, together with findings of autochthonous cases of subcutaneous D. repens infection in human patients from Southeastern Serbia emphasize the need for further investigations of this veterinary and public health problem.

Microbiological aspects of vulvovaginitis in prepubertal girls.

UNLABELLED: This study aimed to establish the vaginal introitus microbial flora in girls with and without symptoms of vulvovaginitis, and to present the distribution of isolated microorganisms by age groups in girls with vulvovaginitis. We enrolled 500 girls with vulvovaginitis symptoms, aged 2-12 years, referred by their pediatricians for microbiological examination of the vaginal introitus swabs, and 30 age-matched asymptomatic girls. Similar microbial flora was isolated in both groups, but the symptomatic girls had significantly more common positive microbiological findings compared to controls (p < 0.001). In symptomatic girls, the following pathogenic bacteria were isolated: Streptococcus pyogenes (4.2%), Haemophilus influenzae (0.4%), and Staphylococcus aureus (5.8%). Bacteria of fecal origin were found in vaginal introitus swabs in 33.8% of cases, most commonly Proteus mirabilis (14.4%), Enterococcus faecalis (12.2%), and Escherichia coli (7.0%). The finding of fecal flora was more common compared to controls, reaching a statistical significance (p < 0.05), as well as in girls aged up to 6 years (p < 0.001). Candida species were found in 2.4% of girls with vulvovaginitis symptoms. CONCLUSION: The microbial ecosystem in girls with clinical signs of vulvovaginitis is complex and variable, and the presence of a microorganism does not necessarily imply that it is the cause of infection. The diagnosis of vulvovaginitis in prepubertal girls requires a complex and comprehensive approach, and microbiological findings should be interpreted in the context of clinical findings.

Correlation between antibiotic consumption and bacterial resistance as quality indicator of proper use of these drugs in inpatients.

BACKGROUND/AIM: Antibiotics are the most frequently used medications in Serbian hospitalized patients. Information about antibiotic utilization and sensitivity among inpatients in Serbia is scanty, and there are no available publications on the topic. The aim of this study was to investigate the correlation between antibiotic use and bacterial resistance in the Clinical Center Nis, one of the biggest hospitals in Serbia. METHODS: The data on antibiotics use in inpatients were obtained from the database of the Department of Pharmacotherapy and expressed as defined daily doses per 100 bed-days (DBD), during 2003-2007. Bacterial resistances were given as percentages of resistant isolates. RESULTS: During the investigation period, the overall consumption of antibiotics had a significant decrease in 2007, by 22.99% (62.23 : 47.92 DBD; p < 0.05). The most frequently used antibiotics were cephalosporins, followed by penicillins, aminoglycosides and quinolones. Hospital aminoglycosides consumption was reduced in 2007 to 59.9% (13.4 : 5.53 DBD) while the resistance to amikacin was reduced from 40.88% to 32.1%. However, utilization of ciprofloxacin had a significant increase in 2007 (120.7%). There was an alarming increase in the level of resistance to ciprofloxacin in our hospital (from 13.5% to 28.3% in Escherichia coli and from 11.1 to 30.09% in Proteus mirabilis). Reduction of E. coli resistant to amoxicillin+clavulanic acid correlated significantly with their utilization, while the resistance for all isolates decreased from 52.16% to 24.40%. CONCLUSIONS: These results confirm an association between the use of antibiotics and the prevalence of resistance. This methodology could provide good quality indicators of rational drug use and serve for local monitoring of antibiotics use and resistance, as well as for external comparison.

[Coagulase-negative Staphylococcus isolated from bloodculture--causes or contaminants?].

INTRODUCTION: According to the results of different investigations, the opinion that isolate of coagulase-negative staphylococci by bloodcultures represents the blood infection in 10-12% patient. The aim of the work was to determine the number of patients with blood infection-sepsa induced coagulase-negative staphylococci isolated by bloodcultures. MATERIAL AND METHODS: The research was done at the Institute for Public Health in Nis. The basic group consisted of 56 patients and coagulase-negative staphylococci were segregated form their bloodcultures. The growth of microorganisms was monitored by the computerized apparatus "Bactec 9120". Coagulase-negative staphylococci were identified by the standard microbiologic method and Vitec AMS system. RESULTS: Eight patients (14.28%) were found to have minimum two signs of blood infection. S. epidermis was isolated in four patients. S. saprophyticus was isolated in the patients on hemodialysis with implanted urinary catheter. S. capitis was isolated in the patients with infarctus miocardi. S. auricularis was isolated in child who was administered the immunosuppressive therapy before and during hospitalization due to an acute asthmatic attack. The isolate of S. simulans was cultivated from samples of the patients hospitalized due to the febrile state. DISCUSSION: A correct interpretation of coagulase-negative staphylococci findings in bloodcultures is an overriding part of medical treatment. The best laboratory indicators of the presence of coagulase-negative staphylococci in blood would be to segregate those of the same kind from two samples at the same time but from different anatomic sites in the presence of clinical signs of blood infection. CONCLUSION: In the investigation conducted at the Public Health Institute-Nis, we determined that bloodcultures isolated coagulase-negative staphylococci represent the blood infection on 14.28% patient.

[Plasmid profile analysis in identification of epidemic strains of Salmonella enterica serovar Enteritidis].

BACKGROUND/AIM: As illness caused by Sallmonella enterica serovar Enteritidis (S. Enteritidis) occurs not only as sporadic cases but as outbreaks, to reveal the source and routes of spreading of infection it is necessary to identify epidemic strain by the use of some typing methods. To determine whether plasmid profile analysis, as genotyping method, could be applied for the investigation of epidemic strains, isolates of S. Enteritidis, recovered from patient's stools and food associated with outbreaks and those isolated from sporadic cases of diarrhea, were investigated. METHODS: Investigation of antibiotic resistance was performed by Kirby-Bauer disc-diffusion method. Isolation of plasmid DNA was carried out by Birnboim and Dolly alkaline lysis method, modified by Ish-Horovitz. RESULTS: Out of 276 izolates of S. Enteritidis 94 were isolated from patient's stools and food associated with outbreaks and 182 were isolated from sporadic cases of diarrhea. The presence of 12 plasmid profiles was established. An average correlation degree of plasmid profiles between the strains was 0.84, that implies high degree of similarity of plasmid profiles of epidemic and non epidemic strains isolated at our geographic region for the given period of time. CONCLUSION: The strains of S. Enteritidis, isolated in outbreaks of enterocolitis as well as from spordic cases of diarrhea in the same period of time and at the same area, frequently exhibit the same plasmid profile characterized by a single plasmid of 38 MDa. Therefore, in most cases plasmid profile analysis is not valuable in the identification of epidemic strains of S. Enteritidis. However, for this purpose plasmid profile analysis could be used when drug-resistant strains of S. Enteritidis are isolated, as they often possess additional resistant plasmids what increases discrimination power of this method.

[Bacteriological finding in the urethra in men with and without non-gonococcal urethritis].

BACKGROUND/AIM: Non-gonococcal urethritis (NGU) is a very common sexually transmitted disease. The etiology of the disease is complex and not completely solved. The aim of this study was to determine the bacteriological finding in the urethra in men with and without non-gonococcal urethritis. METHODS: The study group comprised 200 men with symptoms of urethritis. The control group consisted of 60 men without symptoms of urethritis. The diagnosis of nongonococcal infection was made by finding of an increased number of polymorphonuclear leukocytes (> or = 5) under the microscope in a sample of Gram-stain of urethral smear (x 1 000) and without evidence of Neisseria. gonorrhoeae in specimens (negative direct microscopy and cell culture). Bacteriological examination included: direct microscopy with the Gram-stained and methylblue-stained smears of urethral discharges, and cultivation of specimens under the aerobic/unaerobic conditions. In addition to standard bacterial examination and performinig direct imunofluorescence test to detect Chlamydia trachomatis (bioMerieux, France), urethral smears were also examined for the presence of Ureaplasma urealyticum and Mycoplasma hominis by commercially available Mycofast Evolution 2 test (International Microbio, France). The finding of mycoplasmas > or = 10(4) CCU/ml was positive. The data were statistically analyzed using Pearson chi2 and Student t test. RESULTS: C. trachomatis was predominant bacterial species found in urethra in men with nongonococcal urethritis. It was isolated alone and/or mixed with mycoplasmas and/or other bacteria in 86 (43.0%) of examinees. There was statistically significant difference in finding of C. trachomatis between the study group and the control group (p < 0.001). U. urealyticum was found in men with NGU: 30.2% were with C. trachomatis and 36.0% were without C. trachomatis (p > 0.05). In 16 (8.0%) men with NGU, C. trachomatis was isolated alone, while in 13.0% examinees it occurred with U. urealyticum. Staphylococcus saprophyticus was isolated in one subject with NGU, alone. Streptococcus agalactiae was found in 1.5% of men with urethritis. Anaerobic bacteria were found in 38 (19.0%) subjects with NGU and in 7 (11.7%) subjects from the control group. CONCLUSION: C. trachomatis was predominant bacterial species found in urethra in men with nongonococcal urthretitis. Mixed infections were frequent.

[High-density cervical Ureaplasma urealyticum colonization in pregnant women as a risk factor for premature rupture of membranes].

BACKGROUND/AIM: Ureaplasma urealyticum, a common commensal of the female lower genital tract, has been observed as an important opportunistic pathogen during pregnancy. The aims of this study were to determine the degree of cervical colonization with U. urealyticum in pregnant women with risk pregnancy and in pregnant women with normal term delivery and to evaluate the correlation between high-density cervical U. urealyticum colonization and premature rupture of membranes (PROM) as well. METHODS: This research was conducted on the samples comprizing 130 hospitalized pregnant women with threatening preterm delivery and premature rupture of membranes. The control group consisted of 39 pregnant women with term delivery without PROM. In addition to standard bacteriological examination and performing direct immunofluorescence test to detect Chlamydia trachomalis, cervical swabs were also examined for the presence of U. urealyticum and Mycoplasma hominis by commercially available Mycofast Evolution 2 test (International Microbio, France). RESULTS: The number of findings with isolated high-density U. urealyticum in the target group was 69 (53.08%), while in the control group was 14 (35.90%). Premature rupture of membranes (PROM) occurred in 43 (33.08%) examinees: 29 were pPROM, and 14 were PROM. The finding of U. urealyticum > or = 10(4) was determined in 25 (58.14%) pregnant women with rupture, 17 were pPROM, and 8 were PROM. There was statistically significant difference in the finding of high-density U. urealyticum between the pregnant women with PROM and the control group (chi2 = 4.06, p < 0.05). U. urealyticum was predominant bacterial species found in 62.79% of isolates in the PROM cases, while in 32.56% it was isolated alone. Among the 49 pregnant women with preterm delivery, pPROM occurred in 29 (59.18%) examinees, and in 70.83% of pregnant women with findings of high-density U. urealyticum pPROM was observed. CONCLUSION: Cervical colonization with U. urealyticum > or = 10(4) is more frequent in pregnant women with risk pregnancy than in pregnant women with normal term delivery. High-density cervical U. urealyticum colonization should be observed as a possible etiological factor for PROM.